What is Insomnia? And When Is It Time for Prescription Medication?
Nothing beats lying awake in bed at night, staring at the ceiling or flipping back and forth because you can't sleep. To begin, you could try simple strategies such as counting sheep or listening to a podcast or guided meditation to help you relax and fall asleep. Many people benefit from some behavioural changes, but for others, it is simply insufficient. If you need more assistance sleeping, you may want to consider taking an insomnia medication.
Make sure you’re truly experiencing chronic insomnia.
Everyone has the occasional sleepless night. Maybe you drank a little too much champagne at a wedding reception, or you ate a massive meal that caused heartburn that kept you awake, or you're worried about a workplace conflict. However, a one-time bout of insomnia is not the same as chronic insomnia.
Do you have symptoms of ongoing or chronic insomnia on a regular basis? Here are some common symptoms to help you decide:
Knowing what you're dealing with may make it easier for you and your doctor to decide on the best next steps.
First, try behavioural changes.
Many sleep experts will advise you to start with a few behavioural changes. As the old adage goes, "an ounce of prevention is worth a pound of cure." These steps, or a combination of them, may help you get a good night's sleep most nights and avoid medication:
In addition, your doctor may advise you to try cognitive behavioural therapy for insomnia (CBT-I). In fact, CBT-I is frequently used as a first-line treatment for insomnia.
None of these procedures are invasive. There are no side effects. However, they may be ineffective for some people. So, if you've exhausted all of these options and you're still tossing and turning all night, it might be time to consult your doctor about trying something new.
Consider the prescription medications that are available.
Behavioural changes alone aren't enough for some people to overcome insomnia. If you've tried these behavioural changes and you're still tired all the time, unable to perform your daily responsibilities, experiencing a negative impact on your mental health, or making dangerous mistakes, it may be time to talk to your doctor about medication. There are a few different types of drugs that can be used to treat insomnia. You could begin with an over-the-counter sleep aid or antihistamine. Alternatively, your doctor may advise you to take a prescription medication to treat your specific sleep disorder.
Benzodiazepines are one option for prescription sleep aids. This is an older class of medications that is sometimes used to help people who suffer from chronic insomnia. Estazolam(Prosom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), and triazolam are examples of these medications (Halcion). They work, but some people feel groggy in the morning after taking one. Another factor to consider is that benzodiazepines can lead to dependence–and they are more likely to do so than newer medications. When you try to stop taking them, you may experience some withdrawal symptoms.
Is there another option? Nonbenzodiazepine medications, also known as "Z-drugs," include zaleplon (Sonata), zolpidem (Ambien), and eszopiclone (Lunesta). These medications reduce brain activity, allowing you to fall and stay asleep more easily. They can also cause dependence, though not as frequently as benzodiazepines. The FDA also warns that in rare cases, these drugs can cause "complex sleep behaviours" such as sleepwalking, sleep driving, sleep cooking, and more. If you've had a similar experience, notify your doctor and avoid using Z-drugs.
A newer class of drugs known as orexin receptor antagonists can help with insomnia and are not thought to cause physical dependence. These medications, which include suvorexant (Belsomra) and lemborexant (Dayvigo), have a different effect on the body than other insomnia medications in that they interfere with the body's signals to stay awake, allowing you to fall and stay asleep. They can cause drowsiness the next day, just like other sleep aids.
Other medications that are sometimes used to help people with insomnia include:
All of these medications have a variety of potential side effects, so you and your doctor should carefully discuss your goals for medication and which medications are most likely to work well for you. Furthermore, before recommending any medications, your doctor will want to rule out any other potential medical conditions that may be contributing to your sleeplessness. Medication may also be ineffective if you have certain medical conditions, such as kidney or liver disease.
Find the right solution for you.
Finally, your reaction to behavioural changes or CBT may be decisive. Some people may decide that they are getting enough sleep without the use of medication. If that isn't the case, there are prescription sleep aids that might be worth a shot.